Endocrine Abstracts

Introduction: Pituitary apoplexy describes the ischemic or hemorrhagic phenomenon that occurs in a previous pituitary adenoma. It may be the first manifestation of a pituitary gland adenoma.

Case 1: Female 31 years old macroprolactinoma in irregular treatment with cabergoline for three months Amenorrhea from the age of 14. Decreased visual acuity and oppressive headache. MRI pituitary apoplexy. Hospitalized and discharged with cabergoline and prednisone. Days later genital hemorrhage, a 12-week gestation was confirmed.

Case 2: Male, 40 years old. Two-month history of bitemporal hemianopsia, headache and nausea. MRI Pituitary apoplexy in a 3.5 cm adenoma. Prolactin >1000 ng/dl, other pituitary hormones decreased. Case 3: 53-year-old male, visual acuity deterioration and bilateral gynecomastia. Elevated prolactin. MRI Pituitary gland adenoma. Treatment with cabergoline is started. At 6 months improvement in visual acuity and decrease in prolactin level and tumor size. At 8 months, intense headache, vomiting and sensorium deterioration. New MRI: Extensive area of necrosis and intratumoral hemorrhage.

Discussion: We present 3 cases of prolactinomas that presented apoplexy due to pregnancy, large size of the adenoma and associated with treatment with cabergoline. The state of pregnancy is striking, although pituitary stimulation by estrogens. Its findings are truly exceptional. Another factor associated with pituitary apoplexy is large tumor although this association is generally more frequent non-functioning adenomas Dopaminergic agonists are risk factors for pituitary apoplexy, they cause lactotroph apoptosis. However, the frequency of this effect is rare, since they are drugs of choice in the treatment of prolactinomas.